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Chaica V, Marques R, Pontífice-Sousa P. ISBAR: A Handover Nursing Strategy in Emergency Departments, Scoping Review. Healthcare (Basel) 2024; 12:399. [PMID: 38338283 PMCID: PMC10855820 DOI: 10.3390/healthcare12030399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 02/01/2024] [Accepted: 02/01/2024] [Indexed: 02/12/2024] Open
Abstract
The present work aims to map the available scientific evidence on the benefits of using the ISBAR tool in the nursing care of acutely ill adult patients' handover in an emergency department context. To this end, a scoping review was conducted, according to the guidelines proposed by the Joanna Briggs Institute (JBI), to answer the following research question: "What are the benefits of using the ISBAR tool in the nursing care of acutely ill adult patients' handover in an emergency department context?" The bibliographic search was carried out during August and September 2023 in the following electronic databases: CINAHL Complete; MEDLINE Complete; Cochrane Central Register of Controlled Trials; Cochrane Database of Systematic Reviews; and Cochrane Methodology Register. Only works published between 2013 and 2023 were deemed fit for inclusion. All the included studies (9) show that ISBAR methodology, as a standardized tool for transferring nursing care in the emergency service, allows for a safe, clear, and concise transition of nursing care. The benefits relate to patient and professional safety, continuity, and quality of care, as well as patient and professional comfort, with health gains.
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Affiliation(s)
- Veronica Chaica
- Institute of Health Sciences, Universidade Católica Portuguesa, 1649-023 Lisbon, Portugal;
- Hospital Garcia de Orta, 2805-267 Almada, Portugal
- CIIS-Center for Interdisciplinary Health Research, Universidade Católica Portuguesa, 1649-023 Lisbon, Portugal;
| | - Rita Marques
- CIIS-Center for Interdisciplinary Health Research, Universidade Católica Portuguesa, 1649-023 Lisbon, Portugal;
- Portuguese Red Cross Health School, 1300-125 Lisbon, Portugal
| | - Patrícia Pontífice-Sousa
- Institute of Health Sciences, Universidade Católica Portuguesa, 1649-023 Lisbon, Portugal;
- CIIS-Center for Interdisciplinary Health Research, Universidade Católica Portuguesa, 1649-023 Lisbon, Portugal;
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McCarthy N, Neville K, Pope A, Barry L, Livingstone V. Effectiveness of a proficiency-based progression e-learning approach to training in communication in the context of clinically deteriorating patients: a multi-arm randomised controlled trial. BMJ Open 2023; 13:e072488. [PMID: 37536965 PMCID: PMC10401258 DOI: 10.1136/bmjopen-2023-072488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 06/08/2023] [Indexed: 08/05/2023] Open
Abstract
OBJECTIVE To determine the effectiveness of proficiency-based progression (PBP) e-learning in training in communication concerning clinically deteriorating patients. DESIGN Single-centre multi-arm randomised double-blind controlled trial with three parallel arms. RANDOMISATION, SETTING AND PARTICIPANTS A computer-generated program randomised and allocated 120 final year medical students in an Irish University into three trial groups. INTERVENTION Each group completed the standard Identification, Situation, Background, Assessment, Recommendation communication e-learning; group 1 Heath Service Executive course group (HSE) performed this alone; group 2 (PBP) performed additional e-learning using PBP scenarios with expert-determined proficiency benchmarks composed of weighted marking schemes of steps, errors and critical errors cut-offs; group 3 (S) (self-directed, no PBP) performed additional e-learning with identical scenarios to (PBP) without PBP. MAIN OUTCOME MEASURES Primary analysis was based on 114 students, comparing ability to reach expert-determined predefined proficiency benchmark in standardised low-fidelity simulation assessment, before and after completion of each group's e-learning requirements. Performance was recorded and scored by two independent blinded assessors. RESULTS Post-intervention, proficiency in each group in the low-fidelity simulation environment improved with statistically significant difference in proficiency between groups (p<0.001). Proficiency was highest in (PBP) (81.1%, 30/37). Post hoc pairwise comparisons revealed statistically significant differences between (PBP) and self-directed (S) (p<0.001) and (HSE) (p<0.001). No statistically significant difference existed between (S) and (HSE) (p=0.479). Changes in proficiency from pre-intervention to post-intervention were significantly different between the three groups (p=0.001). Post-intervention, an extra 67.6% (25/37) in (PBP) achieved proficiency in the low-fidelity simulation. Post hoc pairwise comparisons revealed statistically significant differences between (PBP) and both (S) (p=0.020) and (HSE) (p<0.001). No statistically significant difference was found between (S) and (HSE) (p=0.156). CONCLUSIONS PBP e-learning is a more effective way to train in communication concerning clinically deteriorating patients than standard e-learning or e-learning without PBP. TRIAL REGISTRATION NUMBER NCT02937597.
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Affiliation(s)
- Nora McCarthy
- Medical Education Unit, School of Medicine, University College Cork, Cork, Ireland
| | - Karen Neville
- Department of Business Information Systems, Cork University Business School, University College Cork, Cork, Ireland
| | - Andrew Pope
- Department of Business Information Systems, Cork University Business School, University College Cork, Cork, Ireland
| | - Lee Barry
- ESA-BIC, Tyndall Institute, University College Cork National University of Ireland, Cork, Ireland
| | - Vicki Livingstone
- INFANT Centre, University College Cork National University of Ireland, Cork, Ireland
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Kushniruk A, Høigaard R, Berg H, Steinsbekk A, Haraldstad K. Usability Evaluation of the Preoperative ISBAR (Identification, Situation, Background, Assessment, and Recommendation) Desktop Virtual Reality Application: Qualitative Observational Study. JMIR Hum Factors 2022; 9:e40400. [PMID: 36580357 PMCID: PMC9837706 DOI: 10.2196/40400] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 10/27/2022] [Accepted: 11/08/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Systematic communication, such as the ISBAR (identification, situation, background, assessment, recommendation) approach, comprises a generic, transferable nontechnical skill. It can be used during the handover of patients set to undergo surgery and can be practiced in various ways, including virtual reality (VR). VR increasingly has been implemented and valued in nursing education as a positive contribution to teach students about pre- and postoperative nursing. A new nonimmersive 3D learning activity called the Preoperative ISBAR Desktop VR Application has been developed for undergraduate nursing students to learn preoperative handover using the ISBAR approach. However, the usability of this learning activity has not been studied. OBJECTIVE This study aimed to investigate how second-year undergraduate nursing students evaluated the usability of the Preoperative ISBAR Desktop VR Application. METHODS This was a qualitative study with observation and interviews. The inclusion criteria were undergraduate second-year nursing students of varying ages, gender, and anticipated technological competence. The System Usability Scale (SUS) questionnaire was used to get a score on overall usability. RESULTS A total of 9 second-year nursing students aged 22-29 years participated in the study. The average score on the SUS was 83 (range 0-100), which equals a "B" on the graded scale and is excellent for an adjective-grade rating. The students expressed increased motivation to learn while working in self-instructed desktop VR. Still, a few technical difficulties occurred, and some students reported that they experienced some problems comprehending the instructions provided in the application. Long written instructions and a lack of self-pacing built into the application were considered limitations. CONCLUSIONS The nursing students found the application to be usable overall, giving it an excellent usability score and noting that the application provided opportunities for active participation, which was motivational and facilitated their perceived learning outcomes. The next version of the application, to be used in a randomized controlled trial, will be upgraded to address technological and comprehension issues.
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Affiliation(s)
| | - Rune Høigaard
- Department of Sport Science and Physical Education, University of Agder, Kristiansand, Norway
| | - Helen Berg
- Department of Health Sciences, Norwegian University of Science and Technology, Ålesund, Norway
| | - Aslak Steinsbekk
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Kristin Haraldstad
- Department of Health and Nursing Sciences, University of Agder, Kristiansand, Norway
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Toren O, Lipschuetz M, Lehmann A, Regev G, Arad D. Improving Patient Safety in General Hospitals Using Structured Handoffs: Outcomes From a National Project. Front Public Health 2022; 10:777678. [PMID: 35372215 PMCID: PMC8965813 DOI: 10.3389/fpubh.2022.777678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 02/16/2022] [Indexed: 11/21/2022] Open
Abstract
Background Promoting quality and patient safety is one of the health policy pillars of Israel's Ministry of Health. Communication among healthcare professionals is of utmost importance and can be improved using a standardized, well-known handoff tool such as the Introduction, Situation, Background, Assessment, and Recommendations (ISBAR). This study aims to present implementation process and participants' satisfaction of a national project that used a standardized tool for team communication. Methods This national intervention project included process implementation teams from 17 Israeli general hospitals evaluating the ISBAR implementation process for transferring patients from intensive care units to medical/surgical wards. The project, conducted between January 2017 and March 2018, used Fischer's test and logistic regression. The project evaluation was based on the participants' assessment of and satisfaction with the handoff process. Results Eighty-seven process implementers completed the questionnaire. A statistically significant increase in satisfaction scores in terms of four variables (p < 0.001) was observed following the implementation of the project. Nurses reported higher satisfaction at the end of the process (0.036). Participants who perceived less missing information during handoffs were more satisfied with the process of information flow between wards (84.9%) than those who perceived more missing information (15.6%). Participants who responded that there was no need to improve information flow were more satisfied with the project information flow (95.6%) compared to the group which responded that it was necessary to improve information flow (58.2%). Three out of four variables predicted satisfaction with the process. Being a nurse also predicted satisfaction with information flow with a point estimate of 2.4. The C value of the total model was 0.87. Conclusions Implementation of a safety project at a national level requires careful planning and the close involvement of the participating teams. A standardized instrument, a well-defined process, and external controls to monitor and manage the project are essential for success. Disparities found in the responses of nurses vs. physicians suggest the need for a different approach for each profession in planning and executing a similar project in the future.
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Affiliation(s)
- Orly Toren
- Patient Safety and Risk Management, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.,Nursing Department, Ono Academic College, Kiryat Ono, Israel
| | - Michal Lipschuetz
- Patient Safety and Risk Management, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | | | - Gil Regev
- Psyfas, Teamwork and Healthcare, Herzliya, Israel
| | - Dana Arad
- Patient Safety Division, The Israeli Ministry of Health, Jerusalem, Israel
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Schmidt T, Kocher DR, Mahendran P, Denecke K. Dynamic Pocket Card for Implementing ISBAR in Shift Handover Communication. Stud Health Technol Inform 2019; 267:224-229. [PMID: 31483276 DOI: 10.3233/shti190831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A risk factor for patient safety are communication failures among health professionals. Communication standards such as SBAR or ISBAR (situation, background, assessment, recommendation) aim at improving the exchange of information between health professionals by specifying a certain structure and content of information. However, those tools are not well established in daily clinical practice and IT support is missing which results in unstructured, inefficient and error prone information exchange. In this paper, we address this issue by presenting a mobile application that implements the ISBAR communication standard for the intensive care unit (ICU). The system can serve as digital pocket card supporting nurses in preparation for reporting and in a structured information provision during shift handover and in daily reporting. We collected requirements in collaboration with a hospital and developed a prototype. Within the application, nurses can take notes on the five information categories of ISBAR, which allows to reproduce the information in reporting situations in a structured manner. In future, it will be assessed in a pilot phase whether the digital pocket card is suitable for everyday clinical use.
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Pun J, Chan EA, Man M, Eggins S, Slade D. Pre- and post evaluations of the effects of the Connect, Ask, Respond and Empathise (CARE) protocol on nursing handover: A case study of a bilingual hospital in Hong Kong. J Clin Nurs 2019; 28:3001-3011. [PMID: 30938014 DOI: 10.1111/jocn.14871] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 02/15/2019] [Accepted: 03/23/2019] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To evaluate (a) the perceived effects of the training provided to nurses under a standardised Connect, Ask, Respond and Empathise (CARE) protocol; (b) the ability to enhance the effectiveness of the ISBAR checklist; (c) any increase in nurses' spoken interactions and/or improved comprehension of the patient conditions upon the transfer of responsibility. BACKGROUND Nursing handover is a pivotal act of communication with effects on both patient safety and risk management. Previous studies of critical incidents have highlighted ineffective communication, including a lack of interaction and incomplete and unstructured handovers, as a major contributor to patient harm. DESIGN A pre- and post evaluation study involving a questionnaire survey before and after the 3-hours training. METHODS Forty-nine randomly selected bilingual nurses with no previous professional development experience in handover communication were trained according to the CARE protocol, and their perceptions of nursing handovers were assessed before and after training using questionnaire. The STROBE checklist is used (See File S1). RESULTS Training of the CARE protocol improved key areas of the handover process. All participating nurses exhibited significant improvements in their perceptions of effective handover from before to after training. Particularly, improvements were observed in the interactive frequency and quality and completeness of the presented patient information per handover. CONCLUSIONS The nurses reported a deeper understanding of their perceptions of handover after a patient-centred intervention, a better quality of interactions (e.g., querying and checking by incoming nurses), a greater focus when managing handovers and a more complete and comprehensive transfer of information between nurses. RELEVANCE TO CLINICAL PRACTICE CARE protocol-based training yielded significant improvements in nursing handover practice.
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Affiliation(s)
- Jack Pun
- Department of English, The City University of Hong Kong, Hong Kong SAR, China
| | - Engle Angela Chan
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Manbo Man
- Hong Kong Sanatorium and Hospital, Hong Kong SAR, China
| | - Suanne Eggins
- School of Literature, Language and Linguistics, ANU College of Arts and Social Sciences, Australian National University, Canberra, Australia
| | - Diana Slade
- School of Literature, Language and Linguistics, ANU College of Arts and Social Sciences, Australian National University, Canberra, Australia
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Fahim Yegane SA, Shahrami A, Hatamabadi HR, Hosseini-Zijoud SM. Clinical Information Transfer between EMS Staff and Emergency Medicine Assistants during Handover of Trauma Patients. Prehosp Disaster Med 2017; 32:541-7. [PMID: 28606198 DOI: 10.1017/S1049023X17006562] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Introduction Clinical handover by Emergency Medical Services (EMS) staff, as the first people who have contact with trauma patients, in the emergency department (ED), is very important. Therefore, effective communication to transfer clinical information about patients in a concise, rational, clear, and time-bound manner is essential. In Iran, the transfer of necessary information in clinical handover in EDs was carried out orally and without following standard instructions. This study aimed to audit the current clinical handover according to the Identify, Situation, Background, Assessment, and Recommendation (ISBAR) tool and survey the effect of training the ISBAR tool to Emergency Medicine Assistants (EMAs) and EMS staff on improvement of the clinical handover of patients to the ED. METHODS This is a clinical audit study in three phases in Imam Hossein Hospital (Tehran, Iran) during 2016. In the first phase, the clinical handover between EMS staff and EMAs for 178 trauma patients admitted to the ED using ISBAR was audited and information was recorded. In the second phase, the correct approach of clinical handover according to the ISBAR tool was taught to EMS staff and EMAs using pamphlets and lectures. In the third phase, again, the clinical handover between EMS staff and EMAs for 168 trauma patients admitted to the ED was audited using the ISBAR tool and information was recorded. At the end, clinical audit assessment indicators of handover were evaluated before and after training. RESULTS Clinical audit of the current situation in the ED showed that the clinical handover process does not follow standard ISBAR (0.0%). However, after training, 65.3% of clinical handover processes were performed in accordance with ISBAR. In the current study, there was an increase in all parameters of the ISBAR tool after training, most of which increased significantly compared to the first phase of the study (before the intervention). CONCLUSIONS Findings demonstrate that patient handover in the ED did not initially follow the ISBAR standard guideline. After providing education as pamphlets and lectures to EMS staff and EMAs, a high percentage of patient handovers were conducted in accordance with the ISBAR instructions. Fahim Yegane SA , Shahrami A , Hatamabadi HR , Hosseini-Zijoud SM . Clinical information transfer between EMS staff and Emergency Medicine Assistants during handover of trauma patients. Prehosp Disaster Med. 2017;32(5):541-547.
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Scotten M, Manos EL, Malicoat A, Paolo AM. Minding the gap: Interprofessional communication during inpatient and post discharge chasm care. Patient Educ Couns 2015; 98:895-900. [PMID: 25862470 DOI: 10.1016/j.pec.2015.03.009] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 01/12/2015] [Accepted: 03/10/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Poor communication is cited as a main cause of poor patient outcomes and errors in healthcare, and clear communication can be especially critical during transitions such as discharge. In this project, communication was standardized for clarity, and techniques were implemented to continue care from inpatient, to discharge, across the post-discharge chasm, to hand-off with the primary care provider (PCP). METHODS The interprofessional (IP) quality improvement initiative included: (1) evidence-based teamwork system; (2) in situ simulation; (3) creation of an IP model of care; and (4) innovations in use of telehealth technology to continue care post-discharge. RESULTS Measures inpatient/parent satisfaction and the attitudes of the care team have improved. CONCLUSIONS Traditional methods of communication and transition do not meet patient or healthcare provider needs. Communication must be standardized to be understandable and be used by the IP team. Care must continue post-discharge by utilizing technology to increase quality and continuity of care. PRACTICE IMPLICATIONS Improving and practicing communication skills may lead to reductions in healthcare errors and readmissions, and may decrease the length of stay and improve satisfaction of care teams.
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Affiliation(s)
- Mitzi Scotten
- School of Medicine, University of Kansas, Kansas City, USA; Center for Interprofessional Education, University of Kansas, Kansas City, USA
| | - Eva LaVerne Manos
- School of Nursing, University of Kansas, Kansas City, USA; Center for Health Informatics, University of Kansas, Kansas City, USA; Center for Interprofessional Education, University of Kansas, Kansas City, USA.
| | - Allison Malicoat
- University of Kansas Hospital, University of Kansas, Kansas City, USA
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